TB In Children Research Articles

Hubungan Riwayat Kontak dengan Penderita TB Paru Dewasa dan Riwayat Imunisasi BCG dengan Kejadian TB Paru pada Anak RS Husada

Angka kematian anak yang disebabkan TB di Indonesia sebesar 91.368 pertahun atau setiap hari 250 orang meninggal (Depkes RI, 2010). Penelitian ini dilakukan untuk memperoleh gambaran hubungan riwayat kontak dengan penderita TB dewasa dan riwayat imunisasi BCG dengan kejadian TB Paru pada Anak di Ruang Poli Anak RS Husada. Penelitian ini menggunakan metode deskriptif korelatif. Populasi dalam penelitian ini adalah semua pasien anak yang berusia 6 bulan – 12 tahun yang berobat ke Klinik Anak RS Husada Jakarta Pusat pada bulan Maret 2015 - April 2015. Sampel pada penelitian ini sebanyak 41 orang dengan tehnik pengambilan sampel accidental sampling. Hasil penelitian menunjukkan Ada hubungan yang bermakna antara kontak dengan penderita dewasa dengan kejadian TB Paru pada anak di Poli Anak RS Husada dan tidak ada hubungan yang bermakna antara imunisasi BCG dengan kejadian TB Paru pada anak di Poli Anak RS Husada.

Pengalaman Keluarga Yang Merawat Anak Penderita Tb Paru

Pulmonary TB in children is often overlooked or ignored due to symptoms that are not specific in the diagnosis. The purpose of this study was to determine the experience of families caring for children with pulmonary TB in the work area of Lebdosari Community Health Center. Phenomenological approach with taking sampling use purposive sampling of five participants by collecting data through in-depth interviews and field notes. The researcher analyzes the data after and during the research, then to find out the validity of the data using member checking. The parents knew that the child was diagnosed with pulmonary TB from the results of a chest X-ray examination. Feeling sad and distrustful knowing that, when asked parents understand pulmonary TB as a cough, runny nose and fever that does not heal. Efforts include meeting nutritional needs, limiting activities and environmental hygiene. The challenge is when taking medication, the family provides support by assisting in taking the medicine and the parents hope that their child can be completely cured. Children affected by pulmonary TB need proper care include meeting nutritional needs, limiting activities, environmental hygiene and routine treatment, as well as family support needed to overcome obstacles in taking medication during the treatments process.

Clinical profile of pulmonary tuberculosis and MDR TB in children at tertiary medical institute

Background: India is the country with highest burden of TB. There is paucity of data as far as Pediatric TB is concern. TB in children directly reflects intensity of on-going transmission of TB in a given community. This study was done including indoor cases of Pediatric pulmonary TB in a medical college hospital, a tertiary care institute in the city of Mumbai. The aim and objectives of this study the clinical profile and outcome of Pediatric pulmonary tuberculosis/MDR TB in an indoor setting of a tertiary care center. It was a clinical observational study in a setting of medical college hospital.Methods: All admitted children with newly diagnosed pulmonary TB were included in study. A detailed clinical analysis was done. Statistical Analysis Association between two qualitative data was assessed by Chi-Square test, Fisher's exact test for all 2 X 2 tables where Chi-Square test was not valid due to small counts. Comparison of quantitative data measured between two outcomes was done using unpaired t-test. PSPP version 0.8.5 was used for statistical analysis.Results: Total of 41 patients with pulmonary TB were included in the study, making admission rate of 0.7% of total admission. Three out of 41 children had MDRTB making incidence 7% of total TB patients. Severe acute malnutrition was a major risk factor for dissemination of disease and mortality (p value 0.031and 0.0017).Conclusions: The study estimates 0.7% admission rate and 7% as incidence of MDRTB in indoor patients. Severe malnutrition was found to be risk factor for dissemination of disease [p value 0.031].

Prevalence and Clinico- Laboratory Profile of Tuberculosis in Children in Nobel Medical College, Biratnagar

Introduction: Tuberculosis infection is very common, and it continues to be the major public health problem in Nepal. Published data about the epidemiology of TB in children is scarce in Nepal, though it is considered one of the most common causes of childhood morbidity in the country. 
 Aims and objectives: To calculate the prevalence of tuberculosis in children aged 0-15 years and to study their clinico-laboratory profile.
 Methodology: This is a hospital based study conducted in Nobel Medical College Teaching Hospital, Biratnagar over a period of one year. We analyzed 289 children aged 0-15 years suspected of having tuberculosis on clinical grounds and subjected to further screening tests.
 Results: Majority of the children were males and most of the children were 5-15 years of age. 15 of the cases were diagnosed as tuberculosis out of which one case was bacteriologically confirmed pulmonary tuberculosis and be 5.2 %. Fever and cough were the most common clinical presentations and mantoux test and chest X-ray were most suggestive in majority of the cases.
 Conclusions: This study supports the use of history and thorough clinical examination and high index of clinical suspicion for diagnosis of childhood tuberculosis.

Pediatric TB Management under RNTCP: What and Why?

Childhood tuberculosis does not get the attention it deserves, both in the general child health services and the TB specific services. The difficulty in identification of the organism due to lack of proper sample as well as lower sensitivity of the smear, made it harder to detect cases with ease in the community. Newer diagnostic methods like cartridge based nucleic acid amplification tests (CBNAAT) and line probe assays (LPA) have the capacity to rapidly identify Mycobacterium tuberculosis with an improved sensitivity over the smear testing and have been employed under Revised National Tuberculosis Control Programme (RNTCP) across the country. As the symptoms suggestive of TB are very common and overlapping, the final yield of TB testing is better if the microbiological confirmation is done on good quality specimen from cases suspected of TB based on clinical and radiological abnormalities. Newer tests also provide simultaneous detection of much critical Rifampicin resistance. A Rifampicin resistantcase is not only unlikely to respond to first-line standard therapy but such a treatment can result in further amplification of resistance to other companion drugs. Prevention of spread of the drug resistant disease thus requires that the treatment is guided byuniversal drug sensitivity testing (U-DST) of all TB cases. Furthermore, several changes have come up in the treatment of TB and are discussed.The dosages of anti TB drugs have been revised upwardly for optimal drug levels and now the fixed drug combinations are used under RNTCP. With the awareness about high initial Isoniazid (INH) resistance and its contribution to failure of retreatment regime, a companion third drug (Ethambutol) has been added to the continuation phase of the first-line therapy. The standard retreatment regime, better known as category II therapy, has been replaced by specific therapy as per the resistance pattern detected. The TB control activities have thus evolved a lot and the present article discusses the evolution and the current status of diagnostics and therapy of TB in children.

Evaluation of Crofton, Horne, Miller Scoring as Diagnostic Tool for Tuberculosis in Children

Background: Tuberculosis which is caused by Mycobacterium tuberculosis a chronic infectious disease is considered the second most common infectious cause of mortality and morbidity in children around the world. This study was carried out to test the validity of Crofton, Horne and Miller scoring system for the diagnosis of children suffering from tuberculosis.
 Materials and Methods: It was done in an inpatient ward of a pediatric tertiary referral centre, from Feb 2018 to Jan 2019as a prospective case control study, including 92 children aged 2 years to 12 years admitted with clinical differential diagnosis of tuberculosis. Among them 46 children meeting the case definition were taken as cases and 46 were age, sex and disease presentation matched controls.
 Results: Sensitivity of the score was low (50%) but the specificity was high (95%) with 92% positive predictive value and a negative predictive value of 65.67%. Contact with an adult suffering from tuberculosis, positive Mantoux test (>10mm in duration) were found to be the most important indicators of TB in children. Males were found to be affected twice as much as the females.
 Conclusion: From the findings of the study, it can be concluded that the Crofton, Horne, Miller score chart is a simple and cost-effective tool, which can be applied to improve the diagnosis of TB in children due to financial constraints faced by patients in resource limited countries like Nepal.

Pharmacokinetics of adjusted-dose 8-hourly lopinavir/ritonavir in HIV-infected children co-treated with rifampicin.

To evaluate the proportion of children with lopinavir Cmin ≥1 mg/L when receiving a novel 8-hourly lopinavir/ritonavir dosing strategy during rifampicin co-treatment. HIV-infected children on lopinavir/ritonavir and rifampicin were enrolled in a prospective pharmacokinetic study. Children were switched from standard-of-care lopinavir/ritonavir-4:1 with additional ritonavir (1:1 ratio) twice daily to 8-hourly lopinavir/ritonavir-4:1 using weight-banded dosing. Rifampicin was dosed at 10-20 mg/kg/day. After 2 weeks, plasma samples were collected ∼2, 4, 6, 8 and 10 h after the morning lopinavir/ritonavir-4:1 dose, ALT was obtained to assess safety and treatment was switched back to standard of care. ClinicalTrials.gov registration number: NCT01637558. We recruited 11 children in two weight bands: 5 (45%) were 10-13.9 kg and received 20-24 mg/kg/dose of lopinavir and 6 (55%) children weighed 6-9.9 kg and received 20-23 mg/kg/dose of lopinavir. The median age was 15 months (IQR = 12.6-28.8 months). The median (IQR) lopinavir Cmin was 3.0 (0.1-5.5) mg/L. Seven (63.6%) of the 11 children had Cmin values ≥1 mg/L. Children with a lopinavir mg/kg dose below the median 21.5 were more likely to have Cmin <1 mg/L (P = 0.02). There was a strong positive correlation between lopinavir and ritonavir concentrations. No associations were found between lopinavir AUC2-10 and age, sex, weight, nutritional status or mg/kg/dose of lopinavir. These data do not support the use of 8-hourly lopinavir/ritonavir at studied doses. Evaluation of higher doses is needed to optimize treatment outcomes of TB and HIV in young children.

Diagnosis of paediatric tuberculosis by cartridge based nucleic acid amplification test and its effectiveness as compared to the other conventional diagnostic methods

Background: Childhood TB constitutes 10-20% of all TB cases in high burden countries like India and accounting for 8-20% of TB related deaths. Diagnosis of TB in children is difficult. One test, CBNAAT which was recently endorsed by WHO has the potential to lead a revolution in diagnosis of active TB disease.Methods: A cross sectional study in SCB MCH and SVPPGIP, Cuttack in all the suspected TB patients admitted during the period from January 2016 to October 2017.Results: A total of 100 suspicious patients admitted to the Department of Pediatrics in SCB MCH and SVPPGIP during the study period. Of these 45 were diagnosed TB and rest others were diagnosed otherwise than TB. Diagnosis of TB was established on basis of Microscopy, CBNAAT, culture, biochemistry, cytology, clinical findings, neuroimaging, FNAC/biopsy, USG abdomen. Out of 45 TB patients 30 were CBNAAT positive taking the body fluid samples other than blood, urine and stool with a sensitivity of 66.7% and specificity of 100%. Out of 45 TB patients 14 were having ZN Smear positive taking the same fluid sample with a sensitivity of 31.1% and specificity of 100%. Whereas out of these 45 TB patients 32 were MGIT culture positive taking the same sample with a sensitivity of 71.1% and specificity of 100%. When diagnostic performances of CBNAAT and MGIT culture were compared, it was found to be statistically insignificant with a P value 0.54.Conclusions: The CBNAAT is able to confirm a diagnosis of TB with 66.7% sensitivity and 100% specificity within 2 hours. We can use CBNAAT as a diagnostic method as it provides rapid result and simultaneous better sensitive result, it can be helpful in starting ATT in sick patients and also in outdoor patients.

Does the Development of Vaccines Advance Solutions for Tuberculosis?

Mycobacterium tuberculosis (Mtb) is considered as one of the most efficacious human pathogens. The global mortality rate of TB stands at approximately 2 million, while about 8 to 10 million active new cases are documented yearly. It is, therefore, a priority to develop vaccines that will prevent active TB. The vaccines currently used for the management of TB can only proffer a certain level of protection against meningitis, TB, and other forms of disseminated TB in children; however, their effectiveness against pulmonary TB varies and cannot provide life-long protective immunity. Based on these reasons, more efforts are channeled towards the development of new TB vaccines. During the development of TB vaccines, a major challenge has always been the lack of diversity in both the antigens contained in TB vaccines and the immune responses of the TB sufferers. Current efforts are channeled on widening both the range of antigens selection and the range of immune response elicited by the vaccines. The past two decades witnessed a significant progress in the development of TB vaccines; some of the discovered TB vaccines have recently even completed the third phase (phase III) of a clinical trial. The objectives of this article are to discuss the recent progress in the development of new vaccines against TB; to provide an insight on the mechanism of vaccine-mediated specific immune response stimulation, and to debate on the interaction between vaccines and global interventions to end TB.

Pharmacokinetics of Second-Line Anti-Tubercular Drugs.

Multidrug-resistant tuberculosis (MDR TB) has become a major global health concern and is also an issue in children. Children with MDR TB need longer duration of treatment with multiple drugs. The MDR TB treatment regimen usually comprises of a fluoroquinolone, an aminoglycoside, ethionamide, cycloserine, pyrazinamide and ethambutol. In the absence of pediatric friendly tablets/formulations, in most cases the adult tablets are either crushed or broken. This is likely to lead to inaccurate dosing. Very limited information is available on the pharmacokinetics of second-line anti-TB drugs in children with MDR TB, except for few studies from South Africa and one from India. Drugs such as linezolid, clofazimine are also being considered for the treatment of MDR TB in children. However, their pharmacokinetics is not known in the pediatric population. It is important to generate pharmacokinetic studies of drugs used to treat MDR TB in children in different settings, which would provide useful information on the adequacy of drug doses.

Clinical Profile of TB in Children at Pediatric Outpatient Clinic Hasan Sadikin Hospital Bandung 2016

The diagnosis process of TB in children is complicated. Bacteriological exam is needed to establish diagnosis, but it is not possible to be done in children. Clinical symptoms are the main criteria for TB diagnosis in children. This study aimed to provide clinical profile of TB in children and was conducted using descriptive design. The data was taken from medical record of children with TB at RSHS pediatric outpatient clinic from January 2016 to December 2016. We collected 104 subjects using simple random sampling method. We found out that 64 subjects (61.54%) was diagnosed as lung TB and 40 (38.46%) with extra-pulmonary TB. Contact with the source of transmission was found in 33 patients (60%). We found that clinical symptoms of the subjects were fever 2 weeks (62.5%), weight increase difficulty (49%), lymphnode enlargement (36.5%), cough &gt;= 2 weeks (14.4%), chest tightness (7.7%), bone swelling (4%), and night sweats (2%). We concluded that clinical symptoms that are found mostly in children with TB are fever &gt;= 2 weeks, weight increase difficulty, lymphnode enlargement, cough &gt;= 2 week, chest tightness, bony swelling, and night sweats.&#x0D; &#x0D; &#x0D; Keywords: clinical profile, tuberculosis, TB infection in children

Improved Diagnosis of Pulmonary Tuberculosis in Children Using Xpert Ultra on Nasopharyngeal and Induced Sputum Specimens

Rapid diagnosis of pulmonary TB (PTB) in children is desirable. We investigated the diagnostic accuracy of Xpert Ultra, a new rapid test, on repeated induced sputum (IS), nasopharyngeal aspirates (NPAs) and combinations of specimens. Methods: Consecutive South African children hospitalized with suspected PTB were enrolled. Two sequential paired IS and NPAs were obtained. NPAs were frozen; IS underwent liquid culture and an aliquot was frozen. Ultra was performed on thawed NPA and IS samples individually. Children were categorised as confirmed (culture positive), unconfirmed (clinically diagnosed) or unlikely TB (improvement without TB treatment) according to NIH case definitions. The diagnostic accuracy of Ultra was compared with liquid culture on IS. Findings: 195 children [median age 23·3 months, 32(16·4%) HIV-infected] had one IS and NPA; 130 had two NPAs. There were 40(20·5%) culture confirmed cases. Ultra was positive on NPAs in 26(13·3%) and on IS in 31(15·9%) respectively. Sensitivity and specificity of Ultra on one NPA were 45·7% and 97·5% respectively, similar by HIV status. Sensitivity and specificity of Ultra on one IS was 74·3% and 96·9% respectively. Combining one NPA and one IS increased sensitivity to 80%. Sensitivity using two Ultra NPAs was 54.2%, increasing to 87.5% with an IS Ultra. Interpretation: Induced sputum provides a better specimen than repeated NPAs for rapid diagnosis using Ultra, however, Ultra testing of combinations of specimens provides a novel strategy that can be adapted to different settings to identify most children with confirmed PTB. Funding Statement: RePORT TB Consortium, MRC South Africa, NIH (RO1HD058971) Declaration of Interests: FIND is a not-for-profit foundation that supports the evaluation of publicly prioritized tuberculosis assays and the implementation of WHO-approved (guidance and prequalification) assays using donor grants. FIND has product evaluation agreements with several private sector companies that design diagnostics for tuberculosis and other diseases. These agreements strictly define FIND’s independence and neutrality vis-a-vis the companies whose products get evaluated and describe roles and responsibilities. Ethics Approval Statement: The study was approved by the Research Ethics Committee of the Faculty of Health Sciences, University of Cape Town.

Gruźlica w Polsce w 2017 roku

To evaluate the main features of TB epidemiology in 2017 in Poland and to compare with the situation in the EU/EEA countries. Analysis of case- based data on TB patients from National TB Register, data on anti-TB drug susceptibility testing results in cases notified in 2017, data from National Institute of Public Health- National Institute of Hygiene on cases of tuberculosis as AIDS-defining disease, data from Central Statistical Office on deaths from tuberculosis based on death certificates, data from ECDC report „European Centre for Disease Prevention and Control/WHO Regional Office for Europe. Tuberculosis surveillance and monitoring in Europe 2019-2017 data. Stockholm: European Centre for Disease Prevention and Control, 2019”. In 2017, 5 787 TB cases were reported in Poland. The incidence rate was 15.1 cases per 100 000, with large variability between voivodeships from 8.9 to 21.9 per 100 000. The mean annual decrease of TB incidence in 2013-2017 was 4.2%. In 2017, 5127 cases were newly diagnosed with no history of previous treatment i.e. 13.3 per 100 000. 660 cases i.e. 1.7 per 100 000 – 11.4% of all registered subjects were previously treated for tuberculosis. In 2017, the number of all pulmonary tuberculosis cases was 5 531 i.e. 14.4 per 100 000. Pulmonary cases represented 95.6% of all TB cases. In 2017, 256 extrapulmonary TB cases were found. In the whole country there were 68 pediatric cases of tuberculosis. TB in children represented 1.2% of all cases notified in Poland in 2017. The incidence rates of tuberculosis were growing along with the age group from 1.2 per 100 000 among children to 25.6 per 100 000 among subjects in the age group 45-64 years (the highest incidence rate). In 2017, the incidence rate in the age group ≥65 years was 22.6 per 100 000. The TB incidence among men i.e. 22.2 per 100.000 was 2.4 times higher than among women i.e. 8,4 per 100 000. The biggest difference in the TB incidence between the two sex groups occurred in persons aged 45 to 49 years – 36.1 vs. 8.1 and in age group 55- 59 years – 45.2 vs. 10.7. The TB incidence in rural population was lower than in urban, respectively 14.2 per 100.000 and 15.6 per 100 000. The number of all registered culture positive TB cases was 4 179. Pulmonary tuberculosis was bacteriologically confirmed in 4 057 subjects. Culture-confirmed cases represented 72.2% of all TB cases and 73.4% of all pulmonary TB cases. The number of smear-positive pulmonary TB cases reported in 2017 was 2 472 i.e. 6.4 per 100 000 accounting for 44.7% of all pulmonary TB cases and 60.9% of culture confirmed pulmonary TB cases.. TB was AIDS indicative disease in 16 subjects. In all patients with tuberculosis in Poland in 2017 there were 44 cases with MDR-TB (among them 12 foreigners) and 85 patients with resistance to isoniazid only, representing respectively 1.2% and 2.2% of cases with known DST results (DSTs were available in 90.5% of all cultureconfirmed TB cases). In 2017, there were 108 patients of foreign origin among all cases of tuberculosis in Poland. There were 543 deaths due to tuberculosis reported in 2016 – 1.4 per 100 000; 526 people died from pulmonary and 17 from extrapulmonary tuberculosis. Mortality among males – 2.2 per 100 000 – was 3.7 X higher than among females – 0.6. 37.9% of all TB deaths were cases 65 years old and older – 3.3 per 100 000. In 2016, there was one death from tuberculosis in children and no deaths in adolescents. In 2016, tuberculosis represented 0.14% of total mortality in Poland and 28.1% of mortality from infectious diseases. In 2017, the incidence of tuberculosis in Poland was lower than in 2016. Despite a continuous decline it is still higher than the average in the EU/EEA countries. The highest incidence rates were observed in older age groups. The incidence in males was more than 2 times higher than in females. The impact of migration on the characteristics of tuberculosis in Poland is not substantial. In Poland, tuberculosis in children, tuberculosis in persons infected with HIV and MDR-TB is less common than the average in the EU/EEA countries.

Analysis of Factors Associated with Pulmonary Tuberculosis Incidence of Children in Sibuhuan General Hospital

Background: Pulmonary TB patients in Indonesia increase from 1997 to 2014. In 2013 cases of pulmonary TB in children and toddlers have started to be detected in children with age group &lt; 1 year as much as ‰, children with age group 1-4 years as many as 4‰ and children with 5-14 years age group as much as 0.3‰. Purpose: This study aimed to determine the factors that associated with the incidence of pulmonary tuberculosis in Sibuhuan Hospital. Methods: This research used crossectional design and conducted in RSUD Sibuhuan Padang Lawas. The population in this study was all children aged 0-5 years who came treated to lung clinic Sibuhuan RSUD as many as 55 children. Analysis of this study was using chi-square test and measured Pravelence Ratio (PR) to analyze factors related to childhood tuberculosis incident. Results: Children with pulmonary tuberculosis occurred in respondents with male gender as many as 33 children (60%), normal nutritional status as many as 35 children (63,60%), low socioeconomic counted 32 children (58,2%), not getting BCG immunization as many as 32 people (58,2%). There was association between nutritional status (PR = 3,31; 95% CI =1,83 &lt; PR &lt; 5,98), sosioeconomic (PR= 5,51; 95% CI =1,88&lt; PR&lt; 16,182), and BCG immunization (PR = 2,59; CI = 1,15 &lt; PR &lt; 5,33) with incidence of childhood tuberculosis in RSUD Sibuhuan. Conclusion: There was significant between nutritional status, socioeconomic and BCG immunization with incidence of childhood tuberculosis in RSUD Sibuhuan.

Testicular tuberculosis can mimic a testicular tumor

Abstract Testicular tuberculosis (TB Orchitis) is a rare condition with a presentation that mimics testicular tumors. We present a rare case of TB orchitis in a 6-month old male infant who presented with a painless, firm left testicular mass that was initially managed as a testicular tumor but later confirmed to be TB orchitis after histological analysis. The aim of this report is to highlight the similarity of presentation between testicular TB and testicular tumors in children which may only be differentiated histologically therefore creating a diagnostic enigma.

Correlation Between History of ISTC Training on Independent Practicing Doctor With Discovery of TB Suspected Children in Surabaya City

The burden of Tuberculosis in children cases in the world is unknown due to the lack of diagnostic tools that are child friendly and the inadequacy of recording and reporting systems. TB findings in East Java province is second only to west java and the highest number of cases is in Surabaya. The purpose of this study was to analyse the relationship between history of ISTC training with the discovery of TB suspected Children. This research was done with case control design. The case samples were 14 doctors who found suspected TB in children and control sample that was 56 doctors which did not find suspected TB in children. Sampling technique was simple random sampling. Data analysis using Odds Ratio (OR) and 95% CI. The results of the analysis showed that OR value = 5.222 (95% CI 1.470 <OR <18.546). Which means the history of participation or had received training on TB DOTS / ISTC program from independent practice doctor have the chance to find suspected TB Children 5.222 times higher than doctors who have never attended or received any training on the TB DOTS/ISTC program. Suggestions are submitted to the department of health or primary health care to provide training of TB DOTS program to the doctors in the area of Surabaya and cooperate with independent practicing physicians especially in recording and reporting in order to improve case finding, the coverage of TB in children treatment is increasing. Keywords: History of ISTC training, physician practice, TB children

Evaluation of Xpert® MTB/RIF assay as a diagnostic test for pulmonary tuberculosis in children in Myanmar.

The Xpert® MTB/RIF assay has been recommended for the diagnosis of pulmonary tuberculosis (PTB). However, there are limited data from the South-East Asian region. This study was carried out at a tertiary-level children's hospital in Mandalay, Myanmar. To evaluate the performance of Xpert as a diagnostic test for PTB in children. A cross-sectional descriptive study of children with suspected PTB. Gastric lavage aspirate samples were tested using Xpert, solid culture and smear microscopy. The performance of Xpert, solid culture and smear microscopy were evaluated using the revised National Institute of Health classification for intrathoracic TB in children as the reference standard. TB was bacteriologically confirmed in 38 (16.5%) of 231 children with suspected PTB. Of the 38 children with confirmed TB, 36 cases were identified using Xpert, 16 using solid culture and 12 using smear microscopy. With confirmed TB as the reference standard, the sensitivity of Xpert, solid culture and smear microscopy was respectively 94.7% (95%CI 80.9-99.1), 42.1% (95%CI 26.7-59.1) and 31.6% (95%CI 18.0-48.8). Xpert has improved the bacteriological confirmation of PTB among hospitalised children in Myanmar.

Predictors of pediatric tuberculosis in public health facilities of Bale zone, Oromia region, Ethiopia: a case control study

BackgroundTuberculosis is among the top ten cause of death (9th) from a single infectious agent worldwide. It even ranks above HIV/AIDS. It is among the top 10 causes of death among children. Globally there are estimates of one million cases of TB in children, 76% occur in 22 high-burden countries among which Ethiopia ranked 8th. Despite this fact, children with TB are given low priority in most national health programs. Moreover reports on childhood TB and its predictors are very limited. Therefore this study aimed to assess predictors of pediatric Tuberculosis in Public Health Facilities.MethodsUnmatched case control study among a total samples of 432 (144 cases and 288 controls) were done from August to December 2016 in Bale zone, South East Ethiopia. Pediatric TB patients who attended health facilities for DOTS and those who attended health facilities providing DOTS service for any health problem except for TB were the study population for cases and controls, respectively. For each case two consecutive controls were sampled systematically. Data were collected using pretested and structured questionnaire through face to face interview with parents. Binary and multivariable logistic regression analyses were employed to identify predictors of Tuberculosis.ResultAmong cases there were equal number of male and female 71(50%). However among control 136 (47.9%) were male and the rest were female. The mean (standard deviation) of age among cases was 8.4 (±4.3) and controls were 7.3 (±4.1). The odds of TB were 2 times (AOR, 95% CI = 1.94(1.02–3.77)) more likely among 11–15 age group children when compared with children of age group ≤5. HIV status of the child, children who were fed raw milk and absence of BCG vaccination were the other predictors of pediatric TB with AOR 13.6(3.45–53.69), 4.23(2.26–7.88), and 5.46(1.82–16.32) respectively.ConclusionChildren who were not BCG Vaccinated were at risk of developing TB. Furthermore, HIV status, age of the child and family practice of feeding children raw milk are the independent predicators of pediatric TB in the study area.

EXPERIENCE WITH USING RAPID MOLECULAR TESTING IN DIAGNOSING PULMONARY AND EXTRA-PULMONARY PEDIATRIC TUBERCULOSIS IN A NON-ENDEMIC SETTING - A RETROSPECTIVE CASE SERIES

Abstract BACKGROUND Tuberculosis (TB) is a rare but potentially devastating infection among Canadian children. Accurate diagnosis and initiation of treatment are limited in part by the fact that it takes 2–6 weeks for culture results to be confirmed. Xpert MTB/RIF (Xpert) is a rapid, automated molecular assay that has been validated for diagnosing pulmonary but not extra-pulmonary TB in children. OBJECTIVES This was a retrospective study of children investigated for active TB at our facility in order to: 1.Outline demographic characteristics and describe clinical presentations of children diagnosed with active TB. 2.Compare performance of molecular testing (Xpert) to stain and Mycobacterium tuberculosis culture on pulmonary and extra-pulmonary specimens. DESIGN/METHODS We conducted a retrospective chart review of all paediatric patients investigated for active TB at our facility with stain, culture and molecular (Xpert) testing between January 2015 and August 2017. Due to a small number of patients, our data analysis was limited to narrative summary and descriptive statistics. RESULTS A total of 10 children were diagnosed with active TB, including 3 cases of pulmonary, 4 extra-pulmonary and 3 disseminated disease. Age range at diagnosis was 2 months to 16 years, with 3 children younger than 1 year. Most children contracted TB while travelling to and/or being exposed to an index case from endemic areas, including East Asia/Western Pacific (5), South Asia (2) and Africa (1). All children were HIV negative. Time from symptom onset to TB diagnosis and treatment ranged from approximately 4 days to 5 months. Multi-drug resistant TB was confirmed in 1 child. Sadly, 1 child passed away from TB related complications. AFB stain was positive on at least one specimen in 4/10 cases, cultures were positive in 8/10 and molecular testing (Xpert) in 7/10 cases. Time to positive cultures ranged from 10 to 35 days, with an average of 19 days. All cases positive on Xpert were also culture positive. Xpert test diagnosed TB in 5/6 of extra-pulmonary specimens submitted, including pericardial fluid, lymph node tissues and cerebrospinal fluid. CONCLUSION Many paediatric TB patients at our facility are children who have traveled to/have contacts from TB endemic regions, emphasizing the need for obtaining thorough exposure and travel history. Culture and molecular testing demonstrated similar TB detection rates, albeit based on a small patient population. While cultures remain the most reliable diagnostic method, molecular testing may facilitate rapid diagnosis and treatment of pulmonary and extra-pulmonary paediatric TB in a non-endemic setting.

Low Indeterminate Rates Associated With Use of the QuantiFERON-TB Gold In-Tube Test in Children With Inflammatory Bowel Disease on Long-term Infliximab.

Tumor necrosis factor alpha (TNF-α) inhibitors are linked with increased risk of reactivation of active tuberculosis. The QuantiFERON-TB Gold In-Tube test is approved for screening latent tuberculosis infection in children and adults. There are limited data on the test performance in children on long-term treatment with TNF-α inhibitors. The objective of this study was to assess the proportion of indeterminate results for the QuantiFERON-TB Gold In-Tube in children with inflammatory bowel disease (IBD) on long-term infliximab treatment and to evaluate the range of interferon-γ responses to mitogen. A single-center prospective study of children 5 to 19 years of age with IBD on long-term infliximab treatment (>3 months). Each child was assessed for tuberculosis exposure risk and had blood drawn for the QuantiFERON-TB Gold In-Tube. Data on the range of interferon-γ responses and final QuantiFERON-TB Gold In-Tube test results were collected. Ninety-three children were included, with a median age of 16 years. The median total duration of infliximab therapy was 34 months (range, 3-119 months). The QuantiFERON-TB Gold In-Tube was indeterminate in 1 patient (1.1%), positive in 2 patients, and negative in 90 patients. The maximum interferon-γ response to mitogen (10 IU/mL) was observed in 82 patients (88%), with only 1 patient having an inadequate response. The proportion of indeterminate results was significantly lower than the prospectively hypothesized rate of 8%, based on prior studies in nonimmunosuppressed patients (P = 0.004). Pediatric patients with IBD on long-term treatment with infliximab had an adequate interferon-γ response to mitogen and a low indeterminate rate when assessed with the QuantiFERON-TB Gold In-Tube test. This study demonstrates a robust interferon gamma response to phytohemagglutinin stimulation in a pediatric population on long-term therapy with infliximab. The QuantiFERON-TB Gold In-Tube test may therefore be useful as a periodic screening tactic for latent TB in children on long-term infliximab therapy.